Comparative Study of Valved and Nonvalved Fully Implantable Catheters Inserted Via Ultrasound-Guided Puncture for Chemotherapy

Bomfim, Guilherme Andre Zottele; Wolosker, Nelson; Yazbek, Guilherme; Bernardi, C.; Valentim, Luisa Assis; Castro, Thiago Morais de; Pignataro, Bruno Soriano; Benitti, Daniel Augusto; Nishinari, Kenji

doi:10.1016/j.avsg.2013.01.025

Cited by 12 publications

(5 citation statements)

References 22 publications

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“…The purpose of valved catheters is to minimize this unintentional “back flow” of blood into the system while still allowing either flow during aspiration with negative pressure or forward flow with positive pressure . Multiple randomized trials have looked at comparisons between valved and nonvalved catheters, and all agree that there is a lack of difference in the incidence of infection or venous thrombosis with either system but that outcomes differ in terms of clotting and withdrawal failure, which is defined as the inability to draw blood from the device under negative pressure. A 2001 trial by Biffi and colleagues evaluated titanium ports connected to Groshong catheters versus regular open‐ended catheters.…”

Section: Device Designmentioning

confidence: 99%

“…In another study, Carlo and coworkers compared IVADs with a pressure‐activated safety valve at the reservoir and catheter junction with open‐ended IVADs and reported more withdrawal failures with the open‐ended port (11 vs. 5.8%; p = 0.02) . In 2014, a study done with Groshong catheters with standardized insertion technique and catheter sizes again demonstrated higher rates of withdrawal failure in the valved catheters (24 vs. 0%; p < 0.001) . Based on the available data, Groshong valved catheters do not appear to provide an advantage in terms of clotting or occlusion and have no significant differences in terms of other major complications, such as infection or thrombosis, compared with their nonvalved counterparts.…”

Section: Device Designmentioning

confidence: 99%

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Implanted vascular access device options: a focused review on safety and outcomes

Blanco-Guzman

2018

Transfusion

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Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports. Since the first report of a fully implantable vascular access device (IVAD) in 1982, 1 the use of these devices has grown exponentially. They consist of a reservoir cradled in the subcutaneous tissue that is connected to a catheter, with its tip terminating into a major vein. IVADs are frequently used in patients who have poor peripheral venous access and are in need of long-term administration of vesicant drugs, antimicrobials, blood products, or parenteral nutrition.2,3 They also are used as access for long-term therapeutic apheresis procedures. 4 Although nonimplanted, long-term catheters can be used for all of these purposes as well, the lack of an external component in IVAD ports provides multiple advantages; patients have improved perceptions of quality of life and body image and less limitation in their mobility. 5 These ports also minimize the need for maintenance care and risk of infectious complications when the IVAD is not in use. 6 These benefits of IVAD port use have also been demonstrated in pediatric cancer patients, with the added advantage of allowing the child to participate in normal activities and preserving body image. 7Despite the vast experience accrued over the years and the large volume of literature studying factors associated with IVAD port outcomes, early perioperative and late postoperative complications still occur (see Table 1). 8,9 Overall complication rates for IVAD ports reportedly occur in the range from 2% to 18% of all implanted devices. 10-12Port-related infections and venous thrombosis are particularly important, because they are associated with additional morbidity and costs and require removal of the IVAD as part of their treatment in as many as 6.5% of patients. 10 An additional complication specific to the use of IVAD ports during therapeutic apheresis is the occurrence of frequent pressure-related alarms, 13-15 which do not always result in a need to abort the procedure but can delay the duration of the treatments and require additional interventions. 13Here, we present a review focused on techniques, materials, and long-term management options of ports as IVAD options that have an impact on the relevant complications and overall safety profile of th...

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Section: Device Designmentioning

confidence: 99%

Section: Device Designmentioning

confidence: 99%

Implanted vascular access device options: a focused review on safety and outcomes

Blanco-Guzman

2018

Transfusion

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“…4 Exceptionally, the femoral or great saphenous veins can also serve as access, when there is thrombosis of the superior vena cava system. 5 …”

Section: Introductionmentioning

confidence: 99%

Brachial insertion of fully implantable venous catheters for chemotherapy: complications and quality of life assessment in 35 patients

Fonseca¹,

Krutman²,

Nishinari³

et al. 2016

Einstein (São Paulo)

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Objective To prospectively evaluate the perioperative safety, early complications and satisfaction of patients who underwent the implantation of central catheters peripherally inserted via basilic vein.Methods Thirty-five consecutive patients with active oncologic disease requiring chemotherapy were prospectively followed up after undergoing peripheral implantation of indwelling venous catheters, between November 2013 and June 2014. The procedures were performed in the operating room by the same team of three vascular surgeons. The primary endpoints assessed were early postoperative complications, occurring within 30 days after implantation. The evaluation of patient satisfaction was based on a specific questionnaire used in previous studies.Results In all cases, ultrasound-guided puncture of the basilic vein was feasible and the procedure successfully completed. Early complications included one case of basilic vein thrombophlebitis and one case of pocket infection that did not require device removal. Out of 35 patients interviewed, 33 (94.3%) would recommend the device to other patients.Conclusion Implanting brachial ports is a feasible option, with low intraoperative risk and similar rates of early postoperative complications when compared to the existing data of the conventional technique. The patients studied were satisfied with the device and would recommend the procedure to others.

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“…While there is a lack of randomized studies comparing the technical safety of catheter insertion using anatomic landmarks with ultrasound-guided puncture, some studies suggest that the incidence of complications is lower when ultrasound is used during the procedure. In 2014, Zottele Bomfim et al 12 published a study conducted at the Hospital A. C. Camargo, in São Paulo, Brazil, in which 100 cancer patients were divided into two groups and analyzed in terms of the rates of complications associated with placement of a valved versus a non-valved catheter for chemotherapy. While the objective of the study was to compare these two types of catheters, it is interesting to note the existence of a protocol for insertion of these devices, which ensured that all of the people studied had an ultrasonographic assessment of the jugular and subclavian veins prior to puncture, followed by ultrasound-guided CVC placement.…”

Section: Discussionmentioning

confidence: 99%

O papel da ecografia vascular no manejo das complicações associadas ao acesso venoso central para hemodiálise em pacientes oncológicos: relato de dois casos e revisão da literatura

Silva

2018

J. vasc. bras.

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Resumo O implante de cateter venoso central para hemodiálise é comumente realizado em grandes centros e suas complicações estão, por vezes, associadas ao treinamento insuficiente de quem o realiza, mas também às condições clínicas do próprio doente. O presente estudo relata dois casos de intercorrências relacionadas ao uso do cateter de curta permanência para hemodiálise. No primeiro caso, houve inserção inadvertida da cânula na artéria subclávia esquerda e consequente trombose arterial, que foi conduzida conservadoramente, documentando-se uma boa perfusão colateral com ecografia vascular. O segundo caso ilustra o achado incidental de uma trombose venosa séptica central em paciente que havia feito uso do cateter por uma semana, optando-se por tratá-la com antibioticoterapia, anticoagulação plena e controle ecográfico. Em ambos os casos, a intervenção cirúrgica seria de alto risco devido ao prognóstico reservado dos doentes. A ultrassonografia vascular permitiu o monitoramento das situações clínicas e o emprego de terapêutica menos agressiva.

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Comparative Study of Valved and Nonvalved Fully Implantable Catheters Inserted Via Ultrasound-Guided Puncture for Chemotherapy

Cited by 12 publications

References 22 publications

Implanted vascular access device options: a focused review on safety and outcomes

Implanted vascular access device options: a focused review on safety and outcomes

Brachial insertion of fully implantable venous catheters for chemotherapy: complications and quality of life assessment in 35 patients

O papel da ecografia vascular no manejo das complicações associadas ao acesso venoso central para hemodiálise em pacientes oncológicos: relato de dois casos e revisão da literatura

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